Home Health & Hospice

Homecare Aptitude Test: Physician Orders

Homecare Insider, March 8, 2010

Determine whether the following statements about physician orders are true or false.
a. If state regulations and licensure acts permit nurse practitioners to prescribe and treat patients, they can issue and sign orders for patients in a Medicare-certified homecare agency.
b. An order issued by a nurse practitioner will be valid if a physician co-signs it.
c. As of January 1, 2010, a physician must write a paragraph on the certification and recertification plan of care that provides clinical justification for management and evaluation of a care plan.
d. A physician’s order is necessary to screen the patient for depression using the standardized scale incorporated into OASIS-C.

Scroll down for the answers.







Answers to the Homecare Aptitude Test  

Here are the answers to the questions about physician orders.  

a. False.  Even though several states have given prescriptive rights to nurse practitioners, that right does not carry over into home health care.  Medicare statutes for payment and certification say only a physician can issue and sign orders for home health care patients receiving services in a Medicare-certified agency.
b. False.  There is no rule validating a nurse practitioner’s order if it is co-signed by a physician.  Two signatures on a legal document imply that one person is either reviewing or co-signing for the other person.  The nurse practitioner can neither review nor co-sign a physician’s order.  Consequently, anyone reviewing this order would assume that the physician is reviewing or co-signing the nurse’s order.  And that could lead to denials.
It is acceptable for a nurse practitioner to communicate to the homecare agency an order generated by the physician.  She or he is communicating on behalf of the physician.  However, it must be clear that the order is from the physician and eventually countersigned by him or her.
A relevant postscript:  A Beacon Institute member recently reported the denial of several claims because a nurse practitioner signed the orders.
c. True.  The final rule to update the payment rate in the Prospective Payment System for 2010 requires a physician to write a narrative statement about the patient’s clinical needs to justify management and evaluation of a care plan.
d. False.  The Patient Health Questionnaire 2 (PHQ-2) is considered a patient-administered screen.  A clinician can administer this screen as part of the comprehensive assessment without obtaining a physician’s order.

Physician certification of orders is one item in the “Threat Matrix,” on the agenda for the Mastering Medicare in 2010 seminar.  If you plan to attend the Las Vegas seminar on April 12-13, know that special rate for hotel rooms at the Flamingo Las Vegas expires on March 19.  For more details, click on — http://www.beaconhealth.org/item--2010-Mastering-Medicare-Seminar-Las-Vegas-NV:-April-12-13--MMS_041210.html.